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Issue Addressed: Health information can be easily and cheaply provided through the Internet. However, we do not know whether older adults, those people most likely to be living with a chronic disease, are online or whether they use the Internet to find health information.Methods: In order to establish the proportion of older Australians online, the impact of their current health status and chronic disease diagnosis on Internet usage and whether they use the Internet to search for health information, a paper-based survey was developed and mailed to 9000 older adults, resident in New South Wales, Australia (response rate = 46.8% ).Results: Results showed that many older Australians are online (52.3%) and that the majority who are use the Internet to find health information (68.5%). Respondents were more likely to use the Internet if they reported good health. The presence of most chronic diseases reduced use of the Internet; however, this was not the case for those reporting asthma, anxiety or sleep apnoea. Internet use decreased as the number of reported co-morbidities increased. However, once online, self-perceived overall health and number of chronic diseases did not affect use of the Internet to find health information.Conclusions: This study is important as there is currently little information available about Internet use for health information by older Australians. Findings show that the provision of health information online has the potential to reinforce existing barriers created by the social determinants of health. SO WHAT?: There is a role for the Internet in providing preventative, health promotion information, to older adults, who are already online and younger, computer literate audiences. However, practitioners need to consider the fact that this mode of delivery reinforces existing social divides; requires people to have Internet access and be both literate and e-literate. [ABSTRACT FROM AUTHOR]

With the advancement in technology and availability of the Internet, online health education could become one of the media for health education. As health education is to persuade patients on health behavioural change, understanding perceived benefits of online health education is an important aspect to explore. The aim of this study is to explore consumers and health professionals opinion on online health education. Literature review was conducted and identified the benefits of online health education (OHE). Survey was conducted to health consumers and health professionals. Descriptive analyses were performed using SPSS Version 19.0. The analysis of the literature has identified a set of 12 potential benefits of OHE which had been used to understand the perceptions of the effectiveness of OPE sites and these have been validated in the study. This study has the practical implication as the study identified OHE effectiveness, which definitely can assist health practitioners on health education, which can lead to better health outcome. [ABSTRACT FROM AUTHOR]

General practice training is a community of practice in which novices and experts share knowledge. However, there are barriers to knowledge sharing for general practioner (GP) registrars, including geographic and workplace isolation. Virtual communities of practice (VCoP) can be effective in overcoming these barriers using social media tools. The present study examined the perceived usefulness, features and barriers to implementing a VCoP for GP training. Following a survey study of GP registrars and supervisors on VCoP feasibility, a qualitative telephone interview study was undertaken within a regional training provider. Participants with the highest Internet usage in the survey study were selected. Two researchers worked independently conducting thematic analysis using manual coding of transcriptions, later discussing themes until agreement was reached. Seven GP registrars and three GP supervisors participated in the study (average age 38.2 years). Themes emerged regarding professional isolation, potential of social media tools to provide peer support and improve knowledge sharing, and barriers to usage, including time, access and skills. Frequent Internet-using GP registrars and supervisors perceive a VCoP for GP training as a useful tool to overcome professional isolation through improved knowledge sharing. Given that professional isolation can lead to decreased rural work and reduced hours, a successful VCoP may have a positive outcome on the rural medical workforce. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this research is to gain an understanding of the asthma perceptions of older adults and identify gaps in their asthma knowledge. Methods: In regional New South Wales, Australia, a stratified, random sample of 4066 adults, aged 55 years and over, both with and without an asthma diagnosis, completed a survey based on the Health Belief Model about asthma knowledge and perceptions. Results: Almost half of the sample had experienced symptoms of breathlessness in the past four weeks. Breathlessness was a predictor of lower health ratings and poorer mood. Older adults reported low susceptibility to developing asthma. The sample demonstrated poor knowledge of key asthma symptoms including shortness of breath, tightness in the chest and a cough at night. Conclusion: There is a general lack of asthma awareness in this age group. This could result in not seeking medical help, and thus a reduced quality of life. Practical Implications: Older adults should be made aware of key symptoms and the prevalence of asthma in the older adult population, and be empowered to take control of their respiratory health. Audience segmentation for an intervention should be based on recent experience of breathlessness and asthma diagnosis. [Copyright &y& Elsevier]

Adolescents exhibit significantly lower sun protection behaviours than adults in Australia. While many studies have assessed the sun protection behaviours of adolescents during summer, few studies have explored the differences in sun protection behaviours of adolescents across key contexts relevant to adolescents during summer—notably school time, weekends and school holidays. Greater understanding of differences in behaviours across these contexts provides more detailed explanations of the nature of adolescent ultraviolet exposure and thereby facilitates improved targeting of interventions for this segment whose behaviour is considered hard to change. In this study, we explore the differences in self-reported, habitual, sun protection behaviours of adolescents across key contexts during summer. A sample of 692 adolescents aged between 12 and 18 completed a self-report survey concerning habitual sun-related behaviours across four key contexts. Comparisons were made between contexts in seven key sun protection behaviours. The results show that there are significant differences in habitual sun protection behaviours of adolescents between contexts and notably increased compliance with sun protection behaviours in the school context. These findings suggest that some sun protection behaviours are not transferred between key contexts relevant to adolescents and highlight an opportunity for public health programmes to focus more specifically on facilitating the transfer of positive sun protection behaviours between contexts. [ABSTRACT FROM AUTHOR]

The article discusses the effect of sick leave to the health and productivity in workplace of Australian employees. It states that sick leave is considered as a necessary indicator of an employees' health. Moreover, it mentions several aspects of work setting that are potential predictors of sick leave which include job security, job strain, and work schedules.

The article presents a longitudinal study on the relationship of work-related factors and body mass index (BMI) or weight gain among employees in Australia. The study used multinomial logistic regression on its examination on the factors and BMI at 4-year follow up. The study finds that weight increases due to the inflexible working hours and weekend work. The study emphasizes that addressing the factors may play a role in fighting obesity and related health problems among employees.

Purpose: The psychosocial impact of breast cancer varies widely across patients and over time. Greater insight into goal-based coping processes theorised to underpin psychological resilience may inform efforts to support the maintenance and recovery of psychological wellbeing in the context of breast cancer treatment and recovery. This prospective study adopted a qualitative descriptive design to better understand the nature of situational goal-based coping in response to personal goal interference encountered across the six months following surgery for early-stage breast cancer., Method: Responses to specific instances of goal interference were derived from semi-structured interviews conducted at three time-points following surgery (i.e., approximately two, four, and six months post-surgery). Thematic and cross-case analytic techniques were utilised to identify broad patterns across the goal-specific response trajectories., Results: Three broad response patterns were identified - goal-based coping only, combined goal-based coping and other (i.e., informed waiting and/or passive) responses, and informed waiting and/or passive responses only. Specific response patterns were further identified within each category. The majority of response trajectories incorporated the utilisation of assimilative and/or accommodative goal-based coping., Conclusions: Early-stage breast cancer patients utilised goal-based coping in response to many instances of goal-specific interference encountered during the study period. While the initial or delayed activation of these processes appeared generally adaptive, there was also evidence of maladaptive coping and blocked goal pursuit. Further insight into the nature of adaptive and maladaptive goal-based coping in this context could help oncology nurses facilitate ongoing personal goal pursuit and psychological resilience across the cancer continuum., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Telehealth appears to be an ideal mechanism for assisting rural patients and doctors and medical students/registrars in accessing specialist services. Telehealth is the use of enhanced broadband technology to provide telemedicine and education over distance. It provides accessible support to rural primary care providers and medical educators. A telehealth consultation is where a patient at a general practice, with the assistance of the general practitioner or practice nurse, undertakes a consultation by videoconference with a specialist located elsewhere. Multiple benefits of telehealth consulting have been reported, particularly those relevant to rural patients and health care providers. However there is a paucity of research on the benefits of telehealth to medical education and learning., Objective: This protocol explains in depth the process that will be undertaken by a collaborative group of universities and training providers in this unique project., Methods: Training sessions in telehealth consulting will be provided for participating practices and students. The trial will then use telehealth consulting as a real-patient learning experience for students, general practitioner trainees, general practitioner preceptors, and trainees., Results: Results will be available when the trial has been completed in 2015., Conclusions: The protocol has been written to reflect the overarching premise that, by building virtual communities of practice with users of telehealth in medical education, a more sustainable and rigorous model can be developed. The Telehealth Skills Training and Implementation Project will implement and evaluate a theoretically driven model of Internet-facilitated medical education for vertically integrated, community-based learning environments.

A review of the literature was conducted to identify the "active ingredients" needed to produce successful Internet interventions that support older adults in self-management of chronic disease. The term "Internet intervention" was used as an umbrella term to include all online self-management programs. Thirteen articles were found to meet the inclusion criteria from the initial 204 articles identified. Ritterband's Model of Internet Interventions was used as a framework to classify the intervention components reported. It was found that online self-management interventions can improve outcomes for some older adults. However, the wide diversity of interventions and the measures reported, coupled with the complex nature of the studies, made it difficult to identify the "active ingredients." To overcome this problem, the authors propose a minimum reporting set, the Internet Self-Management Uniform Reporting Framework, which can be used in the reporting of all interventions. Internet Self-Management Uniform Reporting Framework proposes the collection of specific data from six domains: Web site design, support, study design, Web site use, user characteristics and reporting outcomes. The adoption of Internet Self-Management Uniform Reporting Framework would enable easy comparison of online interventions targeting chronic diseases.

There are many reasons why online self-management education is attractive to both patients and providers. AsthmaWise, an online self-management program, was developed using a Moodle platform, to enable older adults to learn asthma self-management skills. This study aimed to improve AsthmaWise through conducting: usability testing with a sample of end users; a cognitive walk-through undertaken by an independent health researcher; and assessment of content readability. A Perceived Health Web Site Usability Questionnaire score of 67% was achieved, indicating that there were usability issues that needed to be addressed. The cognitive walk-through and readability assessment identified unique issues that were not identified through usability testing with end users. The testing process allowed issues to be identified and rectified before piloting AsthmaWise, creating a more accessible and refined end product. The involvement of the site designer in the testing process was valuable and is highly recommended. This study shows that usability testing involving both end users and experts is an essential part of the design process that is relatively easy and inexpensive to undertake and can be effectively conducted by a nonexpert.

Obesity is associated with the increased incidence of colon cancer. Many cancer risk factors have been identified including increased blood levels of insulin, leptin, interleukin-6, interleukin-17, tumor necrosis factor-alpha, and decreased blood levels of adiponectin. However, the role of blood levels of estrogen in obesity-associated colon cancer is controversial. Evidence showed that obesity affected men more strongly than women in the carcinogenesis of colon cancer, indicating protective effect of estrogen which is increased in obesity. However, an epidemiological study has also shown that endogenous estradiol level is an independent risk factor for colon cancer, positively associated with colon cancer after normalizing insulin, IGF-1. The controversial opinions may be caused by different effects of ER-alpha and ER-beta. ER-alpha can increase colon cancer cell proliferation and increase cancer incidence. ER-beta has the opposite effect to ER-alpha, and it causes apoptosis of colon cancer cells. The normal colonocytes mainly express ER-beta. Therefore, increased estrogen in obesity may have protective effect via ER-beta in obesity-associated colon cancer. However, with the development of colon cancer, ER-alpha is increased and ER-beta is decreased. In the late stage of colon cancer, estrogen may promote cancer development via ER-alpha. The different effects and expression of ER-alpha and ER-beta may explain the different results observed in several epidemiological studies as well as several animal experiments. Therefore, manipulation of estrogen-caused signal pathways to inhibit ER-alpha and stimulate ER-beta may have preventive and therapeutic effect for obesity-associated colon cancer.

Adherence to public health recommendations around infant and young child feeding is poor amongst Australian parents. This study aimed to investigate Australian parents' awareness and acceptance of public health recommendations about infant feeding. A cross-sectional design was used to survey a convenience sample of Australian parents. A total of 439 surveys were collected by intercept over 2 days from parents of children less than 5 years old, including those expecting a first baby, at the Pregnancy, Babies and Children (PBC) Expo held in Sydney in May 2008. Only 58.3% were aware of the WHO and NHMRC recommendation of 6 months exclusive breastfeeding. Fewer than 70% of respondents indicated that they thought breastfeeding should continue to 12 months or later, in accordance with the NHMRC guidelines, and only 12.3% thought breastfeeding should continue to 24 months or later, in accordance with WHO recommendations. This research suggests that awareness and acceptance of infant feeding recommendations in Australia is poor.

School break times provide a daily opportunity for children to be active; however, research indicates this time is underutilized. Reasons for low children's playground activity levels have primarily focused on physical barriers. This research aimed to contribute to physical environmental findings affecting children's playground physical activity levels by identifying additional variables through the interview process. Thirteen public schools were included in the sample (total 2946 children). Physical activity and environmental data were collected over 3 days. Environmental variables were manually assessed at each of the 13 schools. Observational data were used to determine which three schools were the most and least active. The principal, three teachers and 20 students in Grades 4-6 from these six schools (four lower and two average socioeconomic status) were invited to participate in the interview process. Student interviews involved the paired interview technique. The main themes generated from the school interviews included the effect of non-fixed equipment (including balls), playground markings, playground aesthetics, activity preference, clothing, the amount of break time available for play, teacher playground involvement, gender, bullying, school policies, student confidence in break-time activity and fundamental movement skills. The effect of bullying on playground physical activity levels was concerning.

Background: As our population ages, the proportion of drivers with dementia will continue to rise. Increasingly, health professionals are faced with the clinical dilemma of determining fitness to drive. Unfortunately, the management of drivers with dementia is fraught with hazards., Objective: This article attempts to provide an overview of the complex issue of driving and dementia as it relates to general practitioners in Australia. In addition, an evidence based management strategy is proposed., Discussion: When determining an individual's fitness to drive, a clinician's input may have legal, ethical, emotional and social ramifications. At present, a clear consistent national protocol detailing how one should establish fitness to drive is lacking. There is a need for research addressing how to facilitate early retirement from driving without jeopardising patient-doctor relationships.

Young people, particularly males and those from a rural area, are over represented in road crashes; this occurs in vehicle dependent countries around the world, including Australia. The attitudes, experiences and behaviours of young drivers are some of the key factors which affect their potential to have an early on road driving experience that is crash free. This paper considers the views of young people, some of whom were brought up on rural properties, and had significant, responsible roles in agricultural work, including task related driving from a very early age. This early responsibility and associated awareness of risk of injury in farm related tasks can affect risk perception and impact on later risk taking behaviours. Ten focus groups were conducted with young people attending schools in four towns in rural New South Wales, Australia. These were recorded and analysed using qualitative methodology. The results indicate that risk factors in driving, on and off road, are clearly identified and understood; the majority of young people in rural areas are not "high" risk takers or sensation seekers. They also indicate that, in rural NSW, early vehicle handling, before the age for obtaining a license for driving on roads, is customary practice within the community. Attitudes towards speeding, however, reflect that it is tolerable behaviour, and almost inevitable, and often not considered to be risky. Drink driving is considered more risky, and less acceptable, at both the personal and community levels. Future intervention strategies to reduce crash rates in young rural drivers should aim to address the attitudes and actions associated with speeding on rural roads., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Although the advertising of infant and follow-on formula products in Australia is prohibited by the Marketing in Australia of Infant Formulas: Manufacturers and Importers Agreement (1992), toddler milk is advertised without restriction. Recent research suggests that Australian mothers perceive advertisements for toddler milk to also be advertisements for infant formula. Furthermore, they tend to accept the messages they encounter in these advertisements uncritically. This study used established qualitative market research strategies to investigate what mothers, and those who influence mothers, know about formula milk products. This included exploration of commonly used sources of information, how toddler milk advertisements are interpreted and how the claims made in these advertisements are evaluated. Eight interviews were conducted: two individual interviews (involving a General Practitioner and a Community Dietitian) and six discussion groups (two groups of two mothers, two groups of two grandmothers, one group of two child and family health nurses and one group of five Child and Family Health Nurses). The results suggest that mothers seek advice about formula milk products from health professionals, their friends and their own mothers. The responses also suggest that all of these groups understand toddler milk advertisements to be advertising formula milk products and tend to rely on the messages contained in them to inform their decisions or advice about infant feeding products. It may therefore be difficult for mothers to access independent information upon which to base their decisions about infant feeding products. Further research is needed on whether sufficient independent information about infant feeding products is available to health professionals and mothers.

Background: In Australia, where direct to consumer advertising of prescription medicines is prohibited, pharmaceutical companies can sponsor disease awareness advertising targeting consumers. This study examined the impact of disease awareness advertising exposure on older women's reported behavioural intentions., Method: Women were approached in a shopping centre and randomly assigned mock advertisements for two health conditions. Disease information and sponsors were manipulated., Results: Two hundred and forty-one women responded to 466 advertisements. Almost half reported an intention to ask their doctor for a prescription or referral as a result of seeing the advertisement, but more reported they would talk to their doctor and ask about treatments and tests. Participants were more likely to report an intention to ask for prescriptions if they perceived the health condition to be severe and themselves susceptible or if they had viewed advertisements containing limited information on the disease., Discussion: Disease awareness advertising may stimulate demand for prescription medicine products. This has serious implications for general practitioners and regulators.

Objective: This study investigates and provides comparative data on the relative contributions of multiple physical and psychological health conditions on work productivity., Methods: A total of 667 employees from the headquarters office of a multinational consumer goods manufacturing firm in Germany completed a purpose-designed self-report questionnaire addressing the presence of 13 common health conditions, and associated absenteeism and presenteeism. Adjustments for comorbidity and self-report bias were made using an innovative approach., Results: A total of 34.8% of participants experienced absenteeism and 78.4% experienced presenteeism for at least one health condition. The overall annualized productivity loss due to the 13 health conditions was more than 27 days, equating to 12.3% of employee capacity and about &OV0556;8.78 million for the 1298 persons employed at the site., Conclusions: The combined effects of multiple health conditions on productivity account for a significant proportion of total employee costs.

Objectives: Poor awareness of breast cancer symptoms has been associated with patient delay in seeking help; thus reduced survival, more aggressive treatment, and fewer treatment choices. The aim of this study was to develop a representative picture of Australian women's knowledge of symptoms, experienced potential symptoms, and behavioral responses., Methods: A general population sample of approximately 3,000 women aged 30-69 completed a telephone survey; results were compared to previous surveys conducted in 1996 and 2003., Results: The most commonly cited potential symptom of breast cancer was a lump in the breast, identified by 86% of respondents (an increase from 75% in 2003). Other commonly mentioned symptoms were discharge from the nipple, pain/soreness, skin puckering, or dimpling; and a change in breast shape. The proportion unable to name any potential symptoms of breast cancer decreased from one in ten in 2003 to approximately one in twenty in 2007. The primary reason for not seeking medical advice in response to a potential symptom was the belief that breast cancer was not present., Conclusions: Health promotion efforts need to continue to aim at increasing community understanding of potential breast cancer symptoms and encouraging women to act on potential symptoms by seeking medical advice.

Background: Previous research indicates that older patients may be less willing to consult general practice registrars (GPRs), reducing training opportunities in chronic/complex care. This survey explores older patients' attitudes in order to inform models of interaction that would be acceptable to patients., Methods: Ten training general practices distributed questionnaires for self completion to 50 patients aged 60 years and over. Chi-square, Spearman's rho and logistic regression were used for analysis., Results: The response rate was 47%. Ninety-six percent wanted ongoing contact with their general practitioner if they saw a GPR. Twenty-four percent were comfortable with GPR chronic/complex care, increasing to 73% when there was contact with their usual GP during the consultation., Discussion: This study quantifies a widespread reluctance among older patients to GPRs managing chronic/complex conditions, which could be significantly improved by maintaining a relational link with their regular GP. These results give guidance for training practices and warrant further investigation.

Introduction: Pancreatic cancer (PC) is the sixth leading cause of cancer death in Australia and the fourth in the United States, yet research in PC is lagging behind that in other cancers associated with a high disease burden. In the absence of agreed processes to reliably identify research areas which can deliver significant advances in PC research, the Cancer Council NSW established a strategic partnership with the NSW Pancreatic Cancer Network to define critical research issues and opportunities that could accelerate progress in this field in Australia., Materials and Methods: The process consisted of five distinct stages: a literature review on recent progress in PC research, semi-structured expert interviews, a Delphi process, consumer focus groups, and a nominal group process. Information collected at each step informed the development of subsequent stages., Results: The results from these steps were refined by the nominal group into a set of seven specific pancreatic cancer research goals. The goals were disseminated and led to a new funding scheme for key PC research priorities., Discussion: This prioritisation exercise provided a much needed "road map" for research prioritisation in PC and served as a checklist to researchers applying for PC research grants to confirm how their research can contribute towards accelerating progress in PC research in Australia.

This study utilised semi-structured interviews to investigate how women expecting a first baby perceived print advertisements for 'toddler milks' in order to determine whether they function as indirect advertising for infant and follow-on formula. Examination of the marketing literature, analysis of the advertisers' websites and the advertisements themselves provided sources of triangulation. Fifteen women expecting a first baby were recruited from antenatal classes conducted by staff of the Northern Sydney Central Coast Area Health Service. These respondents clearly understood toddler milk advertisements to be promoting a range of products that included infant and follow-on formula and accepted their claims quite uncritically These claims contradicted public health messages about breastfeeding and the evidence of health risks associated with formula feeding. Toddler milk advertisements appear to function as indirect advertising for infant and follow-on formula. The Marketing in Australia of Infant Formula: Manufacturers' and Importers' Agreement is failing to protect the Australian community from the advertising of breastmilk substitutes as required by World Health Assembly Resolution 33.47, the International Code of Marketing of Breastmilk Substitutes. Further research is recommended to determine whether the responses of this group of primiparous women from a single area in NSW are representative of the wider population of Australian mothers.

Background: Research suggests that older patients may be reluctant to engage general practice registrars (GPRs) in their care. The authors undertook a qualitative study of the attitudes of older patients to GPRs to investigate this issue., Method: Thirty-eight patients aged 60 years and over from three training practices participated in semistructured telephone interviews, which explored patients responses to GPRs. The interviews were recorded, transcribed and analysed using a template analysis approach., Results: Analysis of the interviews produced five major themes concerning patients' attitudes to GPRs: 'desire for continuity', 'desire for access', 'openness', 'trust' and a 'desire for meaningful communication'., Discussion: Older patients' attitudes to GPRs cannot be viewed in isolation from their relationship with their usual general practitioner, and this needs to be taken into account when engaging GPRs in the care of older patients. Systems need to be developed to maintain relational and informational continuity with older patients' 'regular' GP.

VARIATION IN HOW INFORMED CONSENT comprehension tests have been developed may be largely due to the absence of a standardized construct definition. Developing a construct definition would provide a standardized framework for determining how an instrument should be constructed, implemented, interpreted, and applied. Therefore, we utilized the Delphi consensus approach with an international expert panel (N = 19) to gather knowledge, opinions and eventually consensus for a construct definition. Expert consensus was achieved after three revision cycles. While acknowledging that there are limitations to this study, it nonetheless should be considered as a step toward standardization of a construct definition of informed consent comprehension.

The avian influenza A (A/H5N1) virus has attracted the attention of governments and health organizations throughout the world because of its pandemic potential. Despite the emerging nature of A/H5N1, there is limited research on public knowledge and perceptions of this disease. This study is based on a computer-assisted telephone interviewing survey conducted in May 2006 to determine the Australian public's knowledge of A/H5N1, their willingness to engage in preventive behaviors, and their acceptance of potential messages for communication campaigns. Awareness and concern about bird flu is low (lower than a recent survey of U.S. residents). There appears to be widespread support for bird flu control measures initiated by the federal government, although less agreement regarding personal protective behaviors. Our study and those examining the severe acute respiratory syndrome epidemic suggest that governments, including the Australian government, will encounter a number of significant communication challenges in the event of a bird flu outbreak.